Giving birth is both an exciting and terrifying prospect for many expectant mothers. It's normal to have fears, especially if you've learned of or experienced the flaws in the American medical system.
Recent years have seen more research into the prevalence of medical errors in the United States. However, research also highlights a critical preventative measure: that patients advocate for their own care. With more studies finding high rates of childbirth complications in U.S. hospitals, it's time to talk about what "becoming your own advocate" means for expectant mothers.
“There’s this misconception that these complications are rare," said Kristen Terlizzi, co-founder of the National Accreta Foundation, in response to CDC data on childbirth complications. "We [women] get brushed off — ‘The risk is not a big deal.’ But it is.”
The goal of confronting these complications isn't to scare expectant mothers, but to empower them to minimize the risk and maximize their chances of a joyful experience, as childbirth should be. Research on medical errors has shown time and again that the better prepared you are for medical care, the safer your experience and better your outcomes.
Based on this research, we'll share tips on how expectant mothers can prepare themselves, and where medical and non-medical help comes in.
Knowing What "Normal" Looks Like
There's no such thing as “normal,” of course — every childbirth experience is unique. But knowledge of what most mothers can expect from pregnancy, labor, and delivery can go a long way in managing your fears.
One of the first things expectant mothers can do to take their health care into their own hands is to sign up for prenatal (or childbirth education) classes. You learn how to create a birth plan, common procedures at the hospital, what maternity centers and birthing rooms look like, what to bring, and effective methods for managing labor pain, including drug-free options and ways to start physically preparing your body, like prenatal yoga.
See what in-person classes your chosen hospital or birth center offers to spend time in the space you'll be using, or find classes online. Enroll as early as possible — some classes run 12 weeks, which means starting in your second trimester. And the earlier you learn what to expect from your big day, the more opportunities you have to get physically and mentally ready.
Childbirth education is a good supplement to prenatal checkups with your OB-GYN, where you can discuss concerns that come up for you during classes. No question is too stupid or embarrassing for an experienced doctor, so don't hesitate to share what you're afraid of. Just talking it through might help, and your doctor should have ideas for reducing your anxiety.
Planning for the Unexpected
Your prenatal checkups are also an opportunity to ask tough questions. You'll want to know your doctor's approach to special circumstances and threats to your baby's safety. Knowing how they typically respond to the unexpected, you can establish your preferences and expectations up front, rather than having to make critical decisions in the grip of labor.
Pay special attention to your doctor's philosophy on:
- Inducing labor: The decision to induce labor is an important one and should not be taken lightly. Though the procedure can be life-saving, studies have found adverse effects in newborns from certain drugs used to induce labor. If drugs are recommended, you have every right to ask why and if there are any reasonable alternatives.
- Forceps or vacuum delivery: In cases of prolonged labor or fetal distress, your OB-GYN might suggest using forceps or a vacuum extractor to guide your baby out. Be aware that these procedures have been linked to devastating birth injuries to the baby, including permanent disorders like cerebral palsy. You can exercise the right to opt against them.
- Cesarean sections (C-sections): C-sections have been proven safer than forceps for difficult births and may prevent many of the brachial plexus injuries that can cause Erb's palsy in children — but they are still relatively high-risk and should only be recommended when the benefit is worth it. Only about one-third of C-sections are medically justified, according to the Boston University School of Public Health. If you plan for a vaginal birth, you'll want reassurance that your doctor performs C-sections only when absolutely necessary.
- Delivering multiple births: Having more than one baby together comes with more risk. Your OB-GYN should counsel you on the safest way to deliver your babies. It's a good sign if they make special accommodations such as delivering in an operating room, rather than a birthing room, to allow for the additional space necessary for multiple births.
Discuss your options well in advance. This not only prepares you for the inherent challenges of childbirth but also gives you the chance to build rapport with your doctor. Research suggests that active engagement and honest communication between doctor and patient are the basis for successful care outcomes.
Seeking Non-Medical Support
Armed with knowledge of what to expect and a safe birth plan, the last and arguably most important thing expectant mothers need is support. Having a support person during labor and delivery is important because focused attention on the mom's emotional, psychological, and physical needs has been shown to improve birth outcomes.
It's why many women opt to hire a doula: Studies show that with the undivided attention of these trained nonmedical professionals, labor times tend to be shorter and the need for interventions such as epidurals, C-sections, and forceps are reduced by nearly half. Ask if your hospital provides a free doula service or locate a certified doula in your area through dona.org (some insurers will reimburse the fee).
Also consider bringing a loved one. Choose someone you know will be supportive and encouraging. This could be your partner, a friend, or a relative — check your hospital's current COVID restrictions on the number of support people allowed — and there are many ways they can be supportive. Discuss how you want them to help you cope with labor pain, whether that's holding your hand and helping you into different positions, or a more hands-off approach.
Either your doula or support person can be there to advocate for you throughout the process, however you need. Doulas are especially well-informed to catch potential medical errors and advocate for your safety and birth plan.
Preparation With a Dose of Positivity
Birth is a highly emotional process, but approaching it with a sense of what to expect and the right support can ease your concerns and mitigate any complications. Further, approaching labor with a positive attitude can lead to more satisfaction with your experience, and can even reduce pain and risk for C-sections, a study in BMC Pregnancy and Childbirth suggests.
In short, a good self-advocate is one who knows her options and feels good about them. As a patient, it's ok and necessary for you to demand competence and compassion from your care team. This is especially true in an event as big as bringing your baby into the world.